POS1125 EFFICACY OF TUMOR NECROSIS FACTOR INHIBITORS IN HAND OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS
Authors: M. Estee, F. Cicuttini, M. Page, A. Wluka, Y. Wang
Journal: Annals of the Rheumatic Diseases (2022)

Background Hand osteoarthritis (OA) is a leading cause of functional impairment associated with chronic pain and stiffness in hand joints (1) . It is well documented that inflammation plays an important role in the pathogenesis of hand (2) . Therefore, therapies targeting inflammation may offer a novel approach for the management of hand OA. Tumor necrosis factor (TNF) inhibitors are a class of anti-inflammatory drugs that have been used in musculoskeletal conditions (3-5) . Objectives To examine the efficacy of tumor necrosis factor (TNF) inhibitors on symptoms and structural outcomes in hand osteoarthritis. Methods The study was carried out according to PRISMA protocol. Ovid Medline, Embase and Cochrane Central Registry of Controlled Trials were searched from inception to October 2021 for randomized controlled trials examining the efficacy of TNF inhibitors in hand osteoarthritis. We performed quantitative extraction of data and risk of bias assessment for the eligible studies. Where data were available, mean difference was calculated and random effect meta-analysis was performed. Quality of the evidence was assessed using GRADE criteria. Results Four studies were identified involving 276 participants in total. There studies had low risk of bias and one study had some concerns. Meta-analysis showed that TNF inhibitors had no effect on pain at 4-6 weeks and 24-26 weeks and no effect on grip strength at 1 year (Table 1). There was no effect of TNF inhibitors on most of the clinical and structural outcomes. There was conflicting evidence for the effect of TNF inhibitors on radiographic progression, bone marrow lesion or erosive evolution at 12 months. Quality of evidence was low for the effect of TNF inhibitor on pain and moderate for grip strength. Table 1. Effect of TNF inhibitor versus control on pain and grip strength Study scale range Mean (SD) Mean (SD), extracted Mean Difference (95% CI) Number Number Meta-analysis result TNF 1 inhibitor control TNF 1 inhibitor control Short term/pain Aitkin 2018 VAS 2 0-100 -6.1 (22.7) -4.1 (23) -2.5 (-14 to 9) 40 41 -0.93 (-7.41, 5.55) Chevalier 2014 VAS 2 0-100 -19.3 (4.20 -16.8 (4.3) -0.2 (-8.1 to 7.6) 38 35 Long term/pain Kloppenburg2018 VAS 2 0-100 39.2 (24.7) 46.5 (23.4) -5.7 (-15.9 to 4.5) 38 41 -3.82 (-11.46 to 3.83) Chevalier 2014 VAS 2 0-100 -1.4 (-13 to 10.1) 36 33 Long term/grip strength Kloppenburg 2018 Dynamometer 0 (-2.2, 2.1) 41 -0.35 (-1.08, 0.37) Verbruggen 2012 Dynamometer 0.8 (1.2) 1.2 (1.8) 30 30 1 Tumor necrosis Factor, 2 Visual Analogue Scale Conclusion Our systematic review found no effect of TNF inhibitors on clinical outcomes and the effect of TNF inhibitors on structural outcome over longer term is inconclusive. More clinical trials are needed to clarify the role of TNF inhibitors in the management of hand OA. References [1]Haugen IK, Englund M, Aliabadi P, Niu J, Clancy M, Kvien TK, et al. Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study. Ann Rheum Dis. 2011;70(9):1581-6. [2]Sokolove J, Lepus CM. Role of inflammation in the pathogenesis of osteoarthritis: latest findings and interpretations. Ther Adv Musculoskelet Dis. 2013;5(2):77-94 [3]Mantravadi S, Ogdie A, Kraft WK. Tumor necrosis factor inhibitors in psoriatic arthritis. Expert Rev Clin Pharmacol. 2017;10(8):899-910. [4]Ma X, Xu S. TNF inhibitor therapy for rheumatoid arthritis. Biomed Rep. 2013;1(2):177-84. [5]Prince FHM, Dorai Raj AK, Otten MH, Cheung PPM, Tymms KE, van Suijlekom-Smit LWA, et al. TNF-alpha inhibitors for juvenile idiopathic arthritis. The Cochrane Database of Systematic Reviews. 2018;2018(8):CD008598 Disclosure of Interests None declared